Provider Demographics
NPI:1013027879
Name:KOGAN, INNA (MD)
Entity Type:Individual
Prefix:DR
First Name:INNA
Middle Name:
Last Name:KOGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13101 PRESTON RD
Mailing Address - Street 2:SUITE 504
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5231
Mailing Address - Country:US
Mailing Address - Phone:469-791-9000
Mailing Address - Fax:469-791-9011
Practice Address - Street 1:13101 PRESTON RD
Practice Address - Street 2:SUITE 504
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5231
Practice Address - Country:US
Practice Address - Phone:469-791-9000
Practice Address - Fax:469-791-9011
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH96622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E88148Medicare UPIN
00J15LMedicare ID - Type Unspecified